ES2595308T3 - Intramedullary rod with pivoting bra - Google Patents

Abstract

An intramedullary rod for use with a fastener (63) to repair a bone in the body of a mammal including an elongated nail (62) extending along a central longitudinal axis (66) and having a spike (69) and a head (67), including the head (67) a proximal end provided with a proximal opening (103) and being provided with a hole (91) extending at an angle to the longitudinal axis and adapted to receive the fastener (63 ), communicating the hole (91) with a first transverse opening (93) and a second opposite transverse opening (94) in the head (67) in relation to the central longitudinal axis, characterized in that a mechanism (101) is supported by the head (67) and is operable through the proximal opening (103) to engage the fastener (63) adjacent to the second transverse opening (94) of the hole (91) in order to pivot the fastener (63) into the first transverse opening (93) of the hole (91) from a first position inclined in relation to the head (67) to a second inclined position in relation to the head (67), the second transverse opening (94) being elongated to accommodate the fastener pivot (63).

Description

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DESCRIPTION

Intramedullary rod with pivoting clamp Field of the invention

The present invention relates to apparatus for treating bones and, more specifically, to an intramedullary rod for treating femoral fractures.

Background of the invention

Several devices are used to treat femoral fractures. Peritrochanteric femur fractures have been treated with femoral rod assemblies that, for example, are inserted into the femoral duct to co-fit the fractured parts of the femur. One or two inclined transverse nails or locking screws are inserted through the femur and the proximal end of the intramedullary rod.

The nails currently available are provided with static inclined screws that pass through the femoral nail and then achieve adequate fixation resistance in the femur head. They can also have grooves in the nail that allow controlled or uncontrolled dynamic compression of the fracture site in fractures of the subtrocanterics region and below it, with or without an upper sleeve. Frequently, devices that treat fractures of the neck, intertrochanteric and subtrochanteric have variable static angles that need an increased inventory to accommodate several static nail angles.

WO 2005/094707 describes a device for treating a femoral fracture including an elongated element and a fastener that passes through the elongated element. The clamping element includes a ball joint that allows adjusting the angle of the clamping element in relation to the elongate element. US 2002/133156 also describes a device for treating a femoral fracture. It includes an elongated element including a rod and a sleeve. A fastener passes through the sleeve. Depending on the rotational position of the sleeve, the clamping element can be placed in different orientations relative to the rod.

Summary of the invention

An intramedullary rod is provided as set forth in claim 1 for use with a fastener to repair a femur. The rod is an elongated nail that extends along a longitudinal axis and has a spike and a head. The head is provided with a hole that extends along an axis at an angle to the longitudinal axis to receive the fastener. The head supports a mechanism for pivoting the axis of the hole from a first inclined position in relation to the head to a second inclined position in relation to the head. A method for using the rod and the fastener is provided.

Brief description of the drawings

The drawings described herein are for the purpose of illustration only and are not intended to limit the scope of the present description in any way.

Figure 1 is a front view of an embodiment of an intramedullary rod with pivoting fastener of the present invention.

Figure 2 is a side view of the intramedullary rod with pivoting fastener of Figure 1 taken along line 2-2 of Figure 1.

Figure 3 is a rear view, partially in section, of the intramedullary rod with pivoting fastener of Figure 1 taken along line 3-3 of Figure 2.

Figure 4 is an enlarged cross-sectional view of the intramedullary rod with pivoting fastener of Figure 1 taken along line 4-4 of Figure 3.

Figure 5 is an exploded view of the head of the intramedullary rod with pivoting fastener of Figure 1.

Figure 6 is an exploded side view of the head of the intramedullary rod with pivoting fastener of Figure 1 taken along line 6-6 of Figure 5.

Figure 7 is a front view of the intramedullary rod nail with pivoting fastener of Figure 1 with the drive mechanism components removed.

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Figure 9 is a cross-sectional view of the nail of Figure 7 taken along line 9-9 of Figure 7.

Figure 10 is a cross-sectional view of the proximal portion of the nail of Figure 7 taken along line 10-10 of Figure 8.

Figure 11 is a side view of the nail head of Figure 7 taken along line 11-11 of Figure 10.

Figure 12 is a top end view of the nail of Figure 7 taken along line 12-12 of Figure 11.

Figure 13 is a cross-sectional view of the proximal portion of the nail of Figure 7 taken along line 13-13 of Figure 12.

Figure 14 is a perspective view of the intramedullary rod insert with pivoting fastener of Figure 1.

Figure 15 is a top view of the insert of Figure 14 taken along line 15-15 of Figure 14.

Figure 16 is an end view of the insert of Figure 14 taken along line 16-16 of Figure 15.

Figure 17 is a cross-sectional view of the insert of Figure 14 taken along line 17-17 of Figure 16.

Figure 18 is a perspective view of the end nut of the intramedullary rod with pivoting fastener of Figure 1.

Figure 19 is a side view of the end nut of Figure 18 taken along line 19-19 of Figure 18.

Figure 20 is a bottom end view of the end nut of Figure 18 taken along the line 2020 of Figure 18.

Figure 21 is a top end view of the end nut of Figure 18 taken along the line

21-21 of Figure 19.

Figure 22 is a cross-sectional view of the end nut of Figure 18 taken along the line

22-22 of Figure 21.

Figure 23 is a perspective view of the spindle of the intramedullary rod with pivoting fastener of Figure 1.

Figure 24 is a side view of the spindle of Figure 23 taken along line 24-24 of Figure 23.

Figure 25 is a top end view of the spindle of Figure 23 taken along line 25-25 of Figure 24.

Figure 26 is a bottom end view of the spindle of Figure 23 taken along line 26-26 of Figure 24.

Figure 27 is a cross-sectional view of the spindle of Figure 23 taken along line 27-27 of Figure 25.

Figure 28 is a perspective view of the fixation screw of the intramedullary rod with fastener of Figure 1.

Figure 29 is a side view of the fixing screw of Figure 28 taken along line 29-29 of Figure

28.

Figure 30 is an end view of the fixing screw of Figure 28 taken along line 30-30 of Figure 29.

Figure 31 is a cross-sectional view of the fixing screw of Figure 28 taken along line 31-31 of Figure 30.

Figure 32 is a perspective view of the intramedullary rod holder with fastener of Figure 1.

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Figure 34 is an end view of the fastener of Figure 32 taken along line 34-34 of Figure 33.

Figure 35 is a cross-sectional view of the fastener of Figure 32 taken along line 35-35 of Figure 34.

Figure 36 is a front view of the proximal portion of the intramedullary rod with pivoting fastener of Figure 1 depicting the fastener in the first position of Figure 1 relative to the intramedullary rod and the fastener in a second relative position pivoted toward left to the intramedullary rod.

Figure 37 is a cross-sectional view of the proximal portion of the intramedullary rod and pivoting fastener of Figure 1 depicting the fastener in a third position relative to the intramedullary rod.

Figure 38 is a front view of another embodiment of an intramedullary rod with pivoting fasteners of the present invention.

Figure 39 is a side view of the intramedullary rod with pivoting fasteners of Figure 38 taken along line 39-39 of Figure 38.

Figure 40 is a cross-sectional view of the intramedullary rod with pivoting fasteners of Figure 38 taken along line 40-40 of Figure 39.

Figure 41 is a perspective view of the intramedullary rod insert with pivoting fasteners of Figure 38.

Figure 42 is a top view of the insert of Figure 41 taken along line 42-42 of Figure 41.

Figure 43 is an end view of the insert of Figure 41 taken along line 43-43 of Figure 42.

Figure 44 is a cross-sectional view of the insert of Figure 41 taken along line 44-44 of Figure 43.

Figure 45 is a perspective view of the spindle of the intramedullary rod with pivoting fasteners of Figure 38.

Figure 46 is a side view of the spindle of Figure 45 taken along line 46-46 of Figure 45.

Figure 47 is an end view of the spindle of Figure 45 taken along line 47-47 of Figure 46.

Figure 48 is a cross-sectional view of the spindle of Figure 45 taken along line 48-48 of Figure 47.

Figure 49 is a side view of the fixation screw of the intramedullary rod with pivoting fasteners of Figure 38.

Figure 50 is an end view of the fixing screw of Figure 49 taken along the line 50-50 of Figure 49.

Figure 51 is a cross-sectional view of the fixing screw of Figure 49 taken along the line 51-51 of Figure 50.

Figure 52 is a perspective view of the fixing screw of Figure 49 mounted on the spindle of Figure 45.

Figure 53 is a front view of a distal portion of another embodiment of an intramedullary rod with pivoting fasteners of the present invention.

Figure 54 is a front view of a distal portion of another embodiment of an intramedullary rod with pivoting fasteners of the present invention.

Figure 55 is a side view of a distal portion of another embodiment of an intramedullary rod with pivoting fasteners of the present invention.

Figure 56 is an end view of the intramedullary rod with pivoting fastener of Figure 55 taken along line 56-56 of Figure 55.

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arranged in a femur to repair a femoral neck fracture.

Figure 58 is a schematic front view of the intramedullary rod with pivoting fasteners of Figure 38 arranged in a femur to repair an intertrochanteric fracture.

Figure 59 is a schematic front view of the intramedullary rod with pivoting fasteners of Figure 38 arranged in a femur to repair a subtrochanteric fracture.

Detailed description of the invention

In general, an apparatus or device is provided for treating fractures, joint failures or bad joints of the femur or other bones of the body of a mairnfero and includes a rod or intramedullary nail and at least one bra supported by the rod. At least one opening is arranged in the head of the apparatus to slidably receive the one or more fasteners and allow the fastener or fasteners to pivot (n) relative to the head of the apparatus.

In a preferred embodiment, the apparatus 61 of the invention includes an intramedullary rod 62 and a proximal holder 63 pivotally supported by the proximal portion of the rod (see Figures 1-3). The next fastener 63 may be of any suitable type, including a fixing screw, a screw, a pin, a helical blade or any other fixing device, and for reasons of simplicity it is referred to herein as a fixing screw. The femoral nail or rod 62 includes an elongated body 64 that extends along a longitudinal axis 66 and can have a proximal portion or head 67, a central portion or neck 68 and a distal portion or axis 69 ending at a tip distal 71. The elongated body 64 can be curved in at least one portion of the shaft or spindle 69 to align the rod 62 along the length of the medullary canal of the femur when the rod is inserted into the femur. The elongated body 64 may be made of any suitable material such as stainless steel, titanium or other alloy and may have a length, depending in part on the length at which the rod 62 is to be used, of the order of 180 to 500 centimeters . The head 67 of the nail 62 may have a length of the order of 4 to 15 centimeters and preferably of the order of 8 to 12 centimeters and a diameter of the order of 8 to 20 millimeters.

A longitudinally extending passage or hole 76, represented in part in Figures 3-4 and 9-10, can be arranged and extends from a proximal opening 77 in the head 67 to an opening 78 in the tip of the spike for that the rod can slide along a barbed wire during the introduction of the rod into the femur. The curve of the longitudinal axis 66, and therefore the curve of the pin 69 of the rod 62, can be through a single plane or through multiple planes. In the illustrated embodiment of the nail 62, as depicted in Figures 8, 10, 12 and 13, the body curve 64 extends across multiple planes. At least one and, in one embodiment, first and second holes 81, which may extend perpendicular to the longitudinal axis 66, are disposed in the distal end portion of the spike 69 next to the tapered tip 71 of the spike. The holes are sized to receive respective distal fasteners, such as fixing screws, screws, pins, helical blades or any other suitable fixing devices, and in one embodiment such distal fasteners are in the form of fixing screws or screws 82 that can be fixed in an orthogonal angle relative to the pin 69. In the illustrated embodiment and as shown in Figures 1-2 and 7-9, the most distal hole 81 is elongated in its transverse direction, that is, parallel to the longitudinal axis 66 of the pin 69, so that the pin can move longitudinally relative to the respective distal fastener or set screw 82 before tightening the fastener or screw to the underlying portion of the femur.

At least one transverse hole or opening 91 is disposed through the head 67 of the rod 62 and in one embodiment it is inclined towards the proximal end of the rod relative to the longitudinal axis 66 to receive the next fixing screw or screw of fixing 63. More specifically, the one or several transverse holes or holes 91 receives (n) pivotally a fixing screw 63 and allows (n) to change the angle formed between the screw 63 and the nail 62. Each hole or first hole it can be extended through the head 67 in an inclined direction relative to the longitudinal axis 66 such that, when the rod is in position within the medullary canal of the femur, the axis 92 of the opening is directed towards the head of the femur (see figure 13). As can be seen in Figures 5, 6 and 10-13, the transverse hole or hole 91 in the head 67 can communicate with a first or lateral transverse opening 93, through which the respective fixing screw is inserted, and a second or middle opposite transverse opening 94, from which the distal portion of the screw extends. The middle transverse opening 94, as shown in Figures 5, 8, 11 and 13, can be elongated or oblong in a transverse direction, that is to say parallel to the longitudinal axis 66 of the head 67 and the body 64, in order to accommodate the pivot of the distal portion of the next set screw 63.

The head 67 of the rod 62 may include a drive or adjustment mechanism or assembly 101 to selectively pivot the next set screw 63 into the transverse hole 91 (see Figures 4-31). In this regard, the proximal portion of the central passage 76 of the nail 62 may be recessed to form in the head a proximal recess that extends longitudinally 102 and communicates with a proximal opening 103 in the head. As illustrated in Figures 12 and 13, the recess 102 may have a proximal portion 102a, adjacent to the proximal aperture 103, and a segmented circular portion 102b extending in cross section through any suitable angle preferably of the order of 180 at 240 degrees and illustrated in figure 12 as of

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approximately 240 degrees, along the inside of the head 67 adjacent to the middle transverse opening 94. Internal threads 104 may be arranged in the proximal portion 102a. The segmented circular portion or segmented portion 102b of the recess 102 can be formed from an arcuate inner surface 105. The other side of the recess 102, which is the opposite side of the segmented portion 102b, can be formed with a first shelf 107, a second shelf 108 and a third shelf 109 that can extend more radially inwards than the arcuate interior surface 105 of the segmented portion 102b and may have smaller and smaller radii relative to the longitudinal axis 66 (see Figures 11-13) . The proximal portion of the first shelf 107 may optionally be provided with internal threads 111, as shown in Figures 4, 9 and 10. A projection 112 may extend radially inwardly from the first shelf 107 to the second shelf 108 (see Figure 13). The third shelf 109 can support the lateral transverse opening 93, as shown in Figure 11. Transversely aligned grooves 110 can be arranged at the proximal end of the head 67 in the proximal opening 103 to place the nail 62 in correspondence with a template of introduction, orientation device or other suitable device by placing or otherwise manipulating the nail into the desired bone.

Although the drive mechanism 101 for pivoting the next set screw 63 can be of any suitable type, in one embodiment the mechanism 101 includes an insert or sleeve 116, a spindle 117, a safety end or nut 118 and an alignment screw or fastener 119, as depicted in the exploded views of Figures 5-6 and in the assembled view of Figure 4. Each of these components can be made of any suitable material such as stainless steel.

The elongate insert or sleeve 116, as illustrated in Figures 14-17, can be formed from a tubular shaped member 121 that can have a proximal portion 122 and a distal portion 123 and a longitudinally extending opening 124 that extends through one side. The sleeve 116 may be in the form of a cylinder with an elongated cut 126 made along its side, in front of the opening 124, which communicates with the longitudinal hole 127 extending therethrough from the proximal or upper end 128 and the distal or lower end 129. The flat upper and lower ends may extend parallel to each other. As such, the sleeve 116 has a circular or C segmented shape as seen from one end along its longitudinal axis, as shown in Figure 16. Such a cross-sectional configuration of the sleeve 116 preferably approximates the configuration in cross section of the segmented circular portion 102b of the recess 102 in the head 67 and can be extended through an arc of the order of 100 to 360 degrees, preferably of the order of 180 to 240 degrees and illustrated in Figure 16 as about 240 degrees. The elongated transverse opening 124 can be formed in the center of the insert. Such opening 124 may be oblong or elongated in shape and smaller than the middle transverse opening 94 disposed on head 67 of nail 62. Insert 116 may be provided with internal thread 131 extending through hole 127 in the proximal portion 122 of the insert, such threads being adjacent to the upper or near end of the insert as shown in Figures 14 and 17. The insert may have a length of the order of 30 to 110 millimeters and may have an external radius sized to fit within the head 67 of the nail 62. The distal portion of the inner hole 127, that is, the portion of the transverse opening 124 of the distal hole, has an internal diameter smaller than the internal diameter of the proximal portion of the hole.

The spindle 117 can be formed from a cylindrical body 136 provided with a distal portion 137 of constant radius and can have a smooth outer cylindrical surface 138, a central portion 139 adjacent to the distal portion and having external threads 141 extending radially outward relative to the distal portion and a proximal or neck portion 142 adjacent to the central portion (see Figures 18-22). The neck portion may include a proximal flange 143 and an annular recess 144 disposed between the flange and the central portion 139 of the spindle 117. The cylindrical body may also include a proximal or superior end 147 and a distal or inferior end 148, as depicted in Figure 22. The flat ends 148 and 148 may extend parallel to each other. A passage or central hole 151 can be extended through the spindle. The distal portion of the central passage may be provided with internal thread 152 and the proximal portion of the central passage may be provided with any suitable cross-sectional configuration to serve as a drive sleeve 153. The spindle may have a length of the order of 5 at 50 millimeters and preferably about 15 millimeters.

The end nut 118 can be formed from a cylindrical body 161 provided with a distal portion 162 of constant radius and a smooth outer surface 163 and a proximal portion 164 adjacent to the distal portion and having external threads 166 that extend radially out in relation to the distal portion (see figures 2327). The cylindrical body may further include a proximal or upper end 167 and a distal or lower end 168, as shown in Figure 27. The flat ends 167 and 168 may extend parallel to each other. A central passage or hole 171 can be extended longitudinally through the end nut between the ends 167 and 168 and at least the proximal portion of the hole 171 may be provided with some suitable cross-sectional configuration to serve as a drive bushing. . The distal end portion of the end nut may be provided with a recess or bushing 172, which may be in communication with the hole 171 and the side opening to the outer cylindrical surface 163 of the distal portion 162. The bushing 172 may be dimensioned and configured to cooperatively receive the neck portion 142 of the spindle 117 and may include a partial annular flange 173, shown very clearly in Figure 24, which extends radially inwardly to partially seat in the annular recess 144 of the spindle and a partial annular recess 174 extending radially outwardly relative to the flange to receive part of the proximal annular flange 143 of the spindle. The

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End nut can have a length of the order of 5 to 50 millimeters and preferably about 15 millimeters.

The fixing screw 119 may be formed by a cylindrical body 181 provided with a distal portion 182 of constant radius and a smooth outer surface 183 and a proximal portion 184 adjacent to the distal portion and with external threads 186 extending radially outwardly with relation to the distal portion (see figures 2831). The cylindrical body 181 may further include a proximal or upper end 187 and a distal or lower end 188, as shown in Figure 29. A drive bushing 191 of any suitable cross-sectional configuration can be extended longitudinally through at least a portion of the cylindrical body and open at the upper end 187 of the body. The lower end 188 of the body can be blunt. The fixing screw may have a length of the order of 5 to 60 millimeters and preferably about 20 millimeters.

The proximal fastener 63 for use on the head 67 of the intramedullary rod 62 may be of any suitable type and in one embodiment is formed by an elongated cylindrical body 201 or helical blade (not shown) having a length of the order of 40 to 200 millimeters and a diameter of the order of two to 20 millimeters (see Figures 32-35). In the illustrated embodiment, the fastener is a fixing screw formed from a body that has a threaded portion and a smooth portion. The elongate body 201 may be formed of any suitable material such as stainless steel and include a proximal portion 202 having any cylindrical or irregularly shaped outer surface 203. The proximal portion 202 may be provided with multiples, and four longitudinal grooves are shown. 204 extending across surface 203 in circumferentially spaced positions. The distal portion 206 of the body 201 may be provided with external threads 207 extending to a sharp distal end or tip 208 of the body. Alternatively, the distal portion 206 of the body 207 may have an irregular or flat shape (not shown). The body may also have a proximal end 211 and be provided with a central hole 212 that extends longitudinally through the body from the proximal end 211 to the distal end 208 (see Figure 35). The proximal end of the central hole 212 may be provided with internal threads 213 and be formed with a drive bushing 214 of any suitable type to facilitate the connection of the next set screw to a suitable drive tool of any type.

The drive assembly or mechanism 101 can be loaded into the head 67 of the nail 62 in any suitable manner. In an assembly method, the insert 116 is slidably inserted through the proximal opening 103 of the head and slides in the segmented circular portion 102b of the recess 102 in the head. The transverse opening 124 in the insert 116 is generally in correspondence with the middle transverse opening 94 in the head 67. The proximal or neck portion 142 of the spindle 117 sits in the sleeve 172 formed in the distal portion 162 of the end nut 118 so that the end nut and spindle are coaxial along the longitudinal central axes of the end nut and spindle. The combined set of spindle 117 and end nut 118 is loaded into head 67 by introducing distal portion 137 of the spindle into the proximal opening 103 in the head. A suitable drive tool (not shown) can be used to engage the drive sleeve in the central hole 171 in the proximal portion 164 of the end nut to rotate the end nut into the internal threads 104 next to the proximal opening 103 in the head in order to move the end nut 118, and the spindle 117 captured therein, longitudinally to the recess 102 of the head until the spindle seats in the distal portion of the first shelf 107 against the projection 112 extending between the first shelf 107 and the second shelf 108. When the spindle 117 moves distally within the recess 102 of the head 67, the external threads 141 of the spindle engage the internal threads 131 in the proximal portion 122 of the insert 116. The spindle can be moved longitudinally to threaded hitch with the insert by coupling of the actuating sleeve 153 in the proximal or neck portion 142 of the spindle 117 with a tool proper drive and clockwise rotation of the spindle within recess 102 of head 67.

The fixing screw 119 can then be inserted through the central hole 171 of the end nut 118 and into the central hole 151 of the spindle 117 until the external threads 186 arranged in the proximal end portion 184 of the fixing screw engage the internal threads 152 placed inside the distal portion 137 of the spindle. A suitable drive tool can be used to engage the drive sleeve 191 in the proximal portion 184 of the fixing screw 119 to move the fixing screw distally relative to the spindle 117 by the rotational engagement of the external threads 186 in the screw fixing with the internal threads 152 of the spindle. The distal portion 182 of the fixing screw can thus be moved distally with respect to the spindle 117 to the transverse hole 91 in the head 67 of the nail 62.

Upon insertion of the next set screw 63 in the transverse hole 91 of the head 67, and through the transverse opening 124 in the insert 116, the set screw can be pivoted about a transverse axis of the head at an angle of up to 70 degrees and preferably about 30 degrees relative to the nail 62. In one embodiment, illustrated in the figures, the fixing screw 63 can pivot between a first position 216, which extends at an angle a of about 115 degrees relative to the pin 69 of the nail and shown in Figure 36, and a second position 217, which extends at an angle of approximately 145 degrees relative to the nail of the nail and is shown in Figure 37. The screw of fixing is represented in an intermediate position 218, extending at an angle a of approximately 130 degrees in relation to the nail of the nail, in figure 36. Thus, to pivot the fixing screw, in a process dimiento, the doctor turns the spindle

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117 inside the head 67, for example by engaging the drive sleeve 153 in the neck portion 142 of the spindle with a suitable drive tool, so that the external threads 141 in the central portion 139 of the spindle engaging the internal threads 131 inside the insert 116 make the insert move approximately within the head from a first or distal position in the segmented circular portion (not shown) to a second or proximal position in the segmented circular portion, illustrated in Figure 37. The end distal of the transverse opening 124 in the insert 116 engages the fixing screw during the next movement of the insert inside the head 67 causing the fixing screw to pivot within the middle transverse opening 93 of the transverse hole 91 of the head. When in its operative position inside the head 67, shown in Figure 37, the spindle 117 can freely rotate relative to the head and the end cap 118. The fixing screw 119 can be rotated distally with the spindle 117 of so that the blunt end 188 of the fixing screw seats within one of the longitudinal grooves 294 formed in the proximal portion 202 of the fixing screw 63 in order to rotatably lock the fixing screw relative to the head 67 of the intramedullary rod 62 and thus inhibit further unwanted advance or removal of screw 63 relative to rod 62.

Although the drive mechanism 101 of the intramedullary rod 62 has been shown and described with a longitudinally movable insert or sleeve 116 disposed within the nail, it is appreciated that an insert or sleeve slidably positioned outside the nail 62 can be arranged to pivot the fixing screw 62 in relation to the nail.

It is also appreciated that other embodiments of the intramedullary rod of the present invention can be provided, for example with any plurality of pivoting fasteners. Another apparatus 231 is illustrated in Figures 38-52 and may include an intramedullary rod 232 substantially similar to rod 62. Analog reference numbers have been used to describe analog components of rods 62 and 232. Intramedullary rod 232 has proximal fasteners suitable first and second, represented as first and second proximal fixing screws 233 and 234 that may be substantially identical to the proximal fixing screw 63, be pivotally received within respective first and second transverse holes 236 and 237 which may be substantially identical to the transverse hole 91 and extend along respective axes 92. The first and second fasteners 233 and 234 extend parallel to each other, may or may not be the same length and may or may not be of the same type of fastener. For example, the first fastener 233 can be a screw and the second fastener 234 can be a pin or blade. Holes 236 and 237 are arranged in a head 239, substantially similar to head 67, of the rod 232.

A drive mechanism or assembly 241, substantially similar to the drive mechanism 101, may be provided with the head 239 of the rod 232. The drive mechanism 241, shown in a position mounted in Figure 40, may include an insert or sleeve 242 substantially similar to the insert 116 of the mechanism 101, but with first and second transverse holes 246 and 247 similar to the transverse hole 91 of the sleeve 116 and extending at an angle to the longitudinal axis of the nail to receive respectively and pivot the fixing screws first and second 233 and 234 (see Figures 41-44). The axes 92 of the first and second transverse holes 246 and 247 may be parallel to each other, but may also not be parallel to each other. The insert 242 can have a length of the order of 20 to 120 millimeters and an outer radius sized to fit inside the head 239 of the nail 232. A spindle 256 can be provided that is substantially similar to the spindle 117, but formed without the distal portion Spindle 137 117 (see figures 4548). In contrast, the spindle 256 of the double-threaded threaded rod 232 of Figures 38-52 has a proximal or neck portion 142 and a distal portion 257 substantially similar to the central portion 139 of the spindle 117. The spindle 256 may have a length of the order of 5 to 30 millimeters. An end cap or nut 266 substantially similar to end nut 118, but shorter in length, can also be provided (see Figures 4951). The end nut can have a length of the order of 3 to 30 millimeters. The proximal portion 142 of the spindle 256 is shown captured or seated in the bushing 172 in the distal portion 162 of the end nut 266 in Figure 52 so that the spindle and end plug are coaxially aligned in their operative positions one with relationship to another.

The components of the drive assembly 241 can be loaded into the head 239 of the threaded double fixing rod 232, and operated therein with respect to the first and second proximal fixing screws 233 and 234, substantially in the same manner as explained above. with respect to the apparatus 61. The sleeve 242 is shown in Figure 40 in its distal position. The inclusion in the apparatus 241 of the second fixing screw 234 minimizes the need for a fixing screw, such as the fixing screw 119, and preferably eliminates the need for said fixing screw. In this regard, the second proximal fixing screw is included in the means or mechanism of the rod 232 to prevent rotation of the femur head relative to the first proximal fixing screw 233 during the use of the rod 232. It is appreciated that Other means, such as a nail, pin, blade or bolt, may be included in an intramedullary rod of the present invention to inhibit the rotation of the femur head relative to the first set screw. The second optional hole 237 and the second proximal fixing screw 234 allow sliding compression in order to prevent rotation and adapt the device or device to various applications.

Another embodiment of the intramedullary rod with pivoting fasteners of the present invention is illustrated in the figure.

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53 where an apparatus 271 substantially similar to apparatus 61 and 231 is provided. Analog reference numbers have been used to describe analog components of apparatus 61, 231 and 271. The intramedullary rod or nail 272 of apparatus 271 is substantially similar to rods 62 and 232 and has suitable first and second proximal fasteners, represented as first and second proximal fastening screws 233 and 234. The first screw 233 is pivotally received within the first transverse hole 236 extending along the axis 92. The Second screw 234 is pivotally received within a second transverse hole 273 that extends along an axis 274. The hole 273 may be substantially identical to the transverse hole 236 except that the axis 274 of the second transverse hole 273 is not parallel. to the axis 92 of the first transverse hole 236. The first and second fasteners 233 and 234 extend not parallel to each other, may be or not of the same length and may or may not be the same type of bra. Holes 236 and 273 are arranged in a head 276 of the rod 272 which is substantially similar to the head 239 of the rod 232. A drive mechanism or assembly (not shown) substantially similar to the drive mechanism 241 is provided, but modified to provide the non-parallel arrangement of holes 236 and 273.

Another embodiment in the form of apparatus 281 is illustrated in Figure 54 and may include an intramedullary rod 282 substantially similar to rods 62 and 232. Analog reference numbers have been used to describe analog components of rods 62, 232 and 282. Intramedullary rod 282 has suitable first, second and third proximal fasteners, represented as first, second and third proximal fixing screws 233, 234 and 283, pivotally received within respective first, second and third transverse holes 236, 237 and 286. The third Next set screw 283 may be identical to one or both first and second close set screws 233 and 234, and the third cross hole 286 may be identical to one or both first and second cross holes 236 and 237. The first, second fasteners and third 233, 234 and 283 may or may not extend parallel to each other, may or may not be the same length and may or may not be the same. or type of bra. In the illustrated embodiment, fasteners 233, 234 and 283 extend parallel to each other. The holes 236, 237 and 286 are arranged in a head 287 of the rod 282 which is substantially similar to the head 239 of the rod 232. A drive mechanism (assembly not shown) substantially similar to the drive mechanism 241 can be provided. , but modified to provide the third transverse hole 286.

Another embodiment of the intramedullary rod with pivoting fasteners of the present invention is illustrated in Figures 55-56 where an apparatus 296 substantially similar to apparatus 61 and 231 is provided. Analog reference numbers have been used to describe analog components of apparatus 61, 231 and 296. Intramedullary rod or nail 297 of apparatus 296 is substantially similar to rods 62 and 232 and has suitable first and second fasteners, represented as first and second proximal fastening screws 233 and 234. The first screw 233 is received pivotally within first transverse hole 236 extending along axis 92. The second screw 234 is pivotally received within a second transverse hole 298 extending along an axis 299. The second transverse hole 298 can be substantially identical to the first transverse hole 236 except that the axis 299 of the second transverse hole 298 is not parallel to the axis 92 of the first transverse hole 236. More specifically, the axis 299 is circumferentially inclined about the longitudinal axis 66 of the rod 297 relative to the axis 92, as shown in figure 56, the angle 0. The angle 0 can be any number suitable. Axes 92 and 299 may extend at the same angle in relation to the longitudinal axis 66, such as the axes 92 of the rod 232 as shown in Figure 38, or they may extend at different angles in relation to the longitudinal axis 66, such as axes 92 and 274 of rod 272 as shown in Figure 53. The first and second fasteners 233 and 234 may or may not be the same length and may or may not be the same type of fastener. The holes 236 and 298 are arranged in a head 301 of the rod 297 which is substantially similar to the head 239 of the rod 232. A drive mechanism or assembly (not shown) substantially similar to the drive mechanism 241 is provided, but modified to provide the different circumferential alignment of holes 236 and 298.

It can be seen from the various previous embodiments of the intramedullary rod with pivoting fasteners of the present invention that such fasteners can be in any suitable number. Where multiple fasteners are provided, the fasteners can extend parallel to each other or at various angles to each other relative to the longitudinal axis and around the longitudinal axis of the nail. Extrapolations of the illustrated apparatus can be provided, for example where three non-parallel fasteners are provided, where multiple fasteners are circumferentially aligned relative to each other around the longitudinal axis of the rod, but spaced the same distance from the proximal end of the rod or where Two or more first fasteners are circumferentially aligned relative to such a longitudinal axis and one or more second fasteners are circumferentially spaced around said longitudinal axis relative to the first fasteners.

Although the apparatus of the invention has been illustrated with a separate transverse hole in the rod for each fastener, it is appreciated that multiple fasteners can extend pivotally through a single transverse bore. In an embodiment in which a single transverse hole receives two fasteners, one or both of the hole in the rod and the hole in the drive mechanism has a configuration that narrows between two end portions of said hole such that the two fasteners that extend through respective end portions of said hole are separated from each other by the narrowed material of the rod and / or the drive mechanism.

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Several methods for using the intramedullary rod with pivoting fixing screws of the present invention are illustrated in Figures 57-59, where the apparatus 231 with the threaded double fixing rod 232 is shown in use for repairing peritrochanteric fractures of a femur 311 More specifically, the rod 232 is shown repairing a fracture of the femoral neck 316, an intertrochanteric fracture 317 and a subtrochanteric fracture 318, respectively, in Figures 57-59. Prior to the process of the invention, the rod 233 was introduced through the greater trochanter 321 into the medullary canal 322 on the axis 323 of the femur. Suitable holes 324 were made on the side of the larger trochanter to allow the introduction of the first and second fixing screws 233 and 234 into the lateral transverse openings 93 of the respective first and second transverse holes 236 and 237 in the head 239 of the dipstick. The fixing screws were then screwed into the head 326 of the femur 311. In each example, however, additional adjustment of the femur head may be necessary because the fracture is poorly reduced, the point of entry of the rod into the Trocanter was too lateral or a combination of the above. In a process of the invention, a suitable drive element (not shown) is introduced through the entry point 327 in the femur to the opening proximal 103 in the head 239 of the nail 232 and through the end nut 266 so which seats inside the drive sleeve 153 in the neck portion 142 of the spindle 256. The spindle 256 is rotated with the drive element, for example in a clockwise direction, so that the external threads 141 in the spindle engage with the internal threads 131 in the proximal portion 122 of the insert or sleeve 242 and cause the insert 242 to slide or move approximately within the head 239 and thus make each of the first and second proximal fixing screws 233 and 234 pivot towards up towards the head 239 of the rod, that is, in a clockwise direction in figures 57-59, until the fracture is reduced and the head 326 of the femur 311 is removed from the varus and thus placed ad equitably in relation to the rest of the femur, as shown in transparency lines in figures 57-59. The first and second proximal fixing screws are identified with 233 'and 234' in Figures 57-59 when they are in their second position in which they have been pivoted upwardly towards the head 239 of the rod 232.

The capture of the neck portion 142 of the spindle 256 in the bushing 172 of the end nut 266 inhibits the movement of the spindle 256 from its coaxial position with the longitudinal axis of the head 239 and thus inhibits the undesirable movement of the insert 242, and the first and second fixing screws 233 and 234 retained in position by the insert, which may be due to misalignment of the spindle 256 in the head 239 of the rod. The second fixing screw 234 inhibits, if not avoided, the rotation of the head of the femur 326 relative to the first fixing screw 233.

It is appreciated that the apparatus of the invention may include more than two proximal fasteners for fixing the head 326 of the femur, or a portion of any other suitable bone, and falling within the scope of the present invention.

As can be seen from the above, an apparatus is provided to treat fractures of the femur that links the fixation attributes of an intermedullary nail with the benefits of a sliding compression screw. The device provides a single device to treat several femoral fractures, which have so far required more than one device. The device can be used to treat a variety of femoral fractures and femoral osteotoirnas and allows hospitals and manufacturers to reduce the variety of inventories of orthopedic surgical devices and thereby reduce costs. The device allows doctors to pass the fracture or osteotomy to a more favorable position after the implant, and for example allows sliding compression of the femoral neck or intertrochanteric fracture. The device allows the doctor to vary the angle of the next fixation screws that extend to the head of the femur, which can be done before the introduction or after the introduction of the femoral rod into the intramedullary femoral duct.

Claims (6)

5 10 fifteen twenty 25 30 1. An intramedullary rod for use with a fastener (63) to repair a bone in the body of a mairnfero including an elongated nail (62) that extends along a central longitudinal axis (66) and that has a spike ( 69) and a head (67), including the head (67) a proximal end provided with a proximal opening (03) and being provided with a hole (91) extending at an angle to the longitudinal axis and adapted to receive the fastener (63), communicating the hole (91) with a first transverse opening (93) and a second opposite transverse opening (94) in the head (67) in relation to the central longitudinal axis, characterized in that a mechanism (101) is supported by the head (67) and is operable through the proximal opening (103) to engage the fastener (63) adjacent to the second transverse opening (94) of the hole (91) in order to pivot the fastener (63) into the first transverse opening (93) of the hole (91) from a first position n inclined in relation to the head (67) to a second inclined position in relation to the head (67), the second transverse opening (94) being elongated to accommodate the fastener pivot (63). 2. The intramedullary rod of claim 1 for use with an additional fastener (234) wherein the head (239) is provided with an additional hole (237) extending at an angle to the longitudinal axis (66) and adapted to receive the additional fastener (234), communicating the additional hole (237) with a first additional transverse opening (93) and a second opposite additional transverse opening (94) in the head (239), the mechanism (101) being configured to engage the additional fastener (234) adjacent to the second additional transverse opening (94) of the additional hole (237) in order to pivot the additional fastener (234) into the first additional transverse opening (93) of the additional hole (237) from a first inclined position to a second inclined position in relation to the head (237). 3. The intramedullary rod of claim 2, wherein the hole (236) and the additional hole (237) extend parallel to each other. 4. The intramedullary rod of claim 2, wherein the hole (236) and the additional hole (237) do not extend parallel to each other. 5. The intramedullary rod of claim 2, wherein the hole (236) and the additional hole (237) are circumferentially spaced from each other about the longitudinal axis (66). 6. The intramedullary rod of claim 1, wherein the mechanism (101) is disposed within the head (67).